President Barack Obama signed the bipartisan Child Nicotine Poisoning Prevention Act
into law in late January, protecting children from the toxic liquid nicotine used
to refill e-cigarettes. The law, which requires liquid nicotine refills to have child-resistant
packaging, is a major win for children’s health and an important victory for pediatricians
who advocated for its passage.

Coming in bright colors and flavors like cotton candy and gummy bear, liquid nicotine
refills are finding their way into the hands of children at an alarming rate. Exposure
to liquid nicotine, whether through ingestion or absorption through the skin, can
lead to serious illness and even death. According to the American Association of Poison
Control Centers, 3,067 exposures to e-cigarettes and liquid nicotine were reported
in 2015, with more than half occurring in children under the age of 6. Tragically,
one child in upstate New York died from liquid nicotine exposure in 2014.

Dr. Tanski

The Academy called liquid nicotine poisoning an urgent, preventable public health
crisis, and led the push for federal action to protect children. Susanne E. Tanski,
M.D., M.P.H., FAAP, chair of the AAP Tobacco Consortium, represented the Academy at
the first congressional hearing to address e-cigarettes and youths in 2014.

“Who can argue with protecting kids? Everyone wants their children to be safe and
grow up healthy; children being poisoned flies in the face of that,” Dr. Tanski said.
“E-cigarettes and their liquid nicotine refills were flooding the market, which created
a sense of urgency that we needed to act on the poisoning aspect immediately.”

Unlike cleaning supplies and prescription medications, liquid nicotine refills were
not required to have child-resistant packaging. Under the new law, the U.S. Consumer
Product Safety Commission (CPSC) will enforce child-resistant packaging on the products
starting in July.

“These products fell into a unique regulatory void,” said Kyran P. Quinlan, M.D.,
M.P.H., FAAP, chair of the AAP Council on Injury, Violence and Poison Prevention.
“This legislation could not come soon enough. We were really happy Congress could
pass the bill and begin to protect kids by having child-resistant packaging for the
liquid nicotine that people may have in their homes.”

Dr. Quinlan

How AAP, pediatricians led the way

The Child Nicotine Poisoning Prevention Act originally was introduced in the 113th
Congress but did not gain the steam it needed to advance into law. In the 114th Congress,
Sens. Kelly Ayotte (R-N.H.) and Bill Nelson (D-Fla.) and Reps. Susan Brooks (R-Ind.)
and Elizabeth Esty (D-Conn.) re-introduced the legislation and worked together to
advance the bill.

In spring 2015, the legislation served as one of the main advocacy topics for the
AAP Legislative Conference, where more than 130 pediatricians urged their federal
legislators to support the bill.

During the AAP National Conference & Exhibition in October 2015, the Academy released
a new policy statement on electronic nicotine delivery systems, most commonly e-cigarettes,
which called for child-resistant packaging on liquid nicotine refills.

To amplify the Academy’s messages, pediatricians wrote to their local newspapers on
the importance of protecting children from these dangerous products and also served
as child health experts in news coverage on the issue.

The Academy continued to drive the advocacy momentum and engaged members in grassroots
advocacy opportunities. On the morning of the U.S. House of Representatives’ vote
on the final bill, the Academy contacted its Key Contact network, asking pediatricians
to urge their U.S. representatives to pass the legislation. Within hours, the House
passed the bill, sending it to President Obama for his signature.

“The bill and the success of its passage was based on education and relationships.
It was individual pediatricians writing letters or meeting with their legislators
to explain why liquid nicotine poisoning is such an important issue and bringing it
to the forefront,” Dr. Tanski said.

Looking ahead, the Academy will work with CPSC to ensure the law’s implementation
and will continue to advocate for the Food and Drug Administration’s long-awaited
action to regulate all tobacco products, including e-cigarettes.

2016 AAP Legislative Conference

The 25th AAP Legislative Conference will be held April 3-5 in Washington, D.C. Participants
will develop their advocacy skills through interactive workshops, hear from policy
experts and leaders about child health priorities, network with advocates from across
the country and go to Capitol Hill to urge Congress to support children’s health.